The DHS Program User Forum
Discussions regarding The DHS Program data and results
Home » DHS-8 Questionnaire Review - Archived » Core questionnaire: Nutrition » Coverage of Nutritional Interventions during Antenatal Care (ANC)
Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #16770] Fri, 01 March 2019 13:44 Go to next message
DataDENT is currently offline  DataDENT
Messages: 11
Registered: January 2019
Member
Nutrition-specific interventions during pregnancy are a key component of the WHO 2016 Antenatal Care for a Positive Pregnancy Experience guidelines. We propose four indicators that will allow countries to monitor implementation of WHO-recommended dietary counseling and cash/food support interventions.

1. Counseling about healthy eating during pregnancy
Definition: The proportion of women 15-49 who attended ANC for the most recent live birth in the 5 years* preceding the survey that received counseling about what foods to eat during pregnancy.

2. Weight measured during at least 2 ANC visits
Definition: The proportion of women 15-49 who attended ANC for the most recent live birth in the 5 years* preceding the survey that reported weight being measured over at least two ANC visits.
Currently DHS module "Supplemental Module on Maternal Health Care" asks about weight measured during at least once ANC visit.

3. Monitoring of weight gain during pregnancy (weight assessed + talk with provider)
Definition: The proportion of women 15-49 who attended ANC for the most recent live birth in the 5 years* preceding the survey that reported weight being measured over at least two ANC visits AND discussed weight with provider.

4. Received food or cash assistance during pregnancy from government, religious institution or NGO program
Definition: The proportion of women 15-49 who gave birth in the 5 years* preceding the survey that received food or cash assistance while pregnant for their most recent birth.

*We support the forthcoming newborn community's recommendation to modify all Section 4. Pregnancy and Postnatal Care to include live births occurring in the previous 2 years. This would be advantageous to reduce data collection burden, align with MICS, and improve data quality. If this recommendation is adopted, the recall period for this proposed recommendation can be changed to 2 years.

Attached to this post is a completed submission form with full justification for the recommendation.

----------

This recommendation originated in a consultation focused on measuring coverage of programs to support breastfeeding and complementary feeding, co-convened by Alive & Thrive, the International Food Policy Research Institute (IFPRI), and Data for Decisions to Expand Nutrition Transformation (DataDENT). It was further discussed and endorsed at the September 2018 Technical Consultation on Measuring Nutrition in Population-Based Household Surveys and Associated Facility Assessments--a 2-day working meeting convened by the Bill & Melinda Gates Foundation and United States Agency for International Development in collaboration with the World Health Organization (WHO) and United Nations Children's Fund (UNICEF), and coordinated by DataDENT. The consultation included more than 60 technical experts, survey program representatives from DHS, MICS, LSMS and SMART, country data stakeholders, and donors from the nutrition measurement community.

This recommendation was authored by IFPRI and reviewed by Laurence Grummer-Strawn (WHO), Chika Hayashi (UNICEF), Chessa Lutter (RTI), and Monica Kothari (PATH).

This recommendation is endorsed by the WHO-UNICEF Technical Expert Advisory Group on Nutrition Monitoring (TEAM). Out of the 10 sets of recommendations endorsed by TEAM, this recommendation was prioritized as Tier 1 of 3 (critical data need).

This recommendation is also endorsed by Countdown to 2030, Alive & Thrive, the nutrition team at the Bill & Melinda Gates Foundation, and the Department of International Health at the Johns Hopkins Bloomberg School of Public Health.

[Updated on: Fri, 01 March 2019 13:56]

Report message to a moderator

Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #16841 is a reply to message #16770] Thu, 07 March 2019 16:57 Go to previous messageGo to next message
Marie Ruel is currently offline  Marie Ruel
Messages: 11
Registered: April 2014
Member
I support the recommendation for including the 4 questions proposed and using the recall period of 2 years.

I would recommend a small change on question 4: The proportion of women 15-49 who gave birth in the 5 years* preceding the survey that received food or cash assistance while pregnant for their most recent birth.

"received food or cash" should be more specific as for example: "received food or cash from government, United Nations, or NGO program". Otherwise the question could capture food or cash donations from family or friends.


Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #16894 is a reply to message #16770] Wed, 13 March 2019 15:29 Go to previous messageGo to next message
sjiwani1 is currently offline  sjiwani1
Messages: 1
Registered: March 2019
Member
I support this recommendation, particularly with regards to improving the measurement of antenatal care quality, beyond coverage.

I see Indicator 4 on receipt of food or cash assistance being especially relevant in countries with large-scale conditional cash transfers (CCT) programs. It is my understanding that ENDES (Peru DHS) captures such data in relation to the JUNTOS CCT, although it is not specifically asked in the context of pregnancy. In some CCT programs, antenatal care contacts could be a "condition" met for receiving the cash or food, therefore it may also be valuable to capture this additional information for programmatic purposes.
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #16901 is a reply to message #16770] Wed, 13 March 2019 21:34 Go to previous messageGo to next message
SUN Movement MEAL Team
Messages: 9
Registered: March 2019
Member
The SUN MEAL Results Framework seeks to track the coverage of nutrition interventions targeted to women during pregnancy. The data from these additional questions would be very useful in this regard.

We recommend prioritizing indicator #3 since it gives a better understanding on the "quality" of the service. We believe that indicator #2 (assessing weight) is not as useful.

We currently have no source of data on dietary interventions during pregnancy that is comparable across the 60 SUN countries. We are currently restricted to monitoring proportion of population benefiting from social protection programmes; the addition of a question on receipt of food or cash assistance during pregnancy would enable us to track these nutrition-specific actions for our specific target group of interest (women during pregnancy).
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #16910 is a reply to message #16770] Thu, 14 March 2019 01:50 Go to previous messageGo to next message
Mauro Brero is currently offline  Mauro Brero
Messages: 12
Registered: March 2019
Member
UNICEF Tanzania proposes to maintain indicators 1, 2 and 3 as maternal nutrition is increasingly a priority in the country, and this information is highly needed for evidence based planning and programming to improve ANC services.

We propose to maintain both indicators 2 and 3, because this will provide clearer information on where is the bottleneck in ANC services, i.e. on measuring weight, or providing counselling based on measurements.

We propose to remove indicator 4, because it is very programme specific and is not relevant for Tanzania which is mostly a food secure country where there is no need of food assistance for pregnant women.

UNICEF Nutrition Team Tanzania.
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #16933 is a reply to message #16770] Thu, 14 March 2019 05:48 Go to previous messageGo to next message
Geeta Verma is currently offline  Geeta Verma
Messages: 5
Registered: March 2019
Member
I support the four questions. For question 4, I suggest additional probes to make this data more meaningful for programs

4. Received food or cash assistance during pregnancy from government, religious institution or NGO program

(a) What kind of food assistance
(i) Take home rations at regular intervals e.g. monthly
(ii) Daily hot cooked meal near home
(iii) Specific food e.g protein rich foods pulses, fortified foods
(b) Total Cash assistance received

Cash assistance through government programs is often in the form of large scale conditional cash transfers. Getting this additional information regarding food / cash assistance will be valuable for programmatic purpose .
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #16975 is a reply to message #16770] Thu, 14 March 2019 15:29 Go to previous messageGo to next message
jruelbergeron is currently offline  jruelbergeron
Messages: 8
Registered: March 2019
Member
The Global Financing Facility (GFF) Secretariat endorses the recommendations made in this document (DataDENT).
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #17003 is a reply to message #16901] Fri, 15 March 2019 06:04 Go to previous messageGo to next message
kdearden is currently offline  kdearden
Messages: 4
Registered: March 2019
Member
IMA World Health Tanzania also supports these indicators. Like SUN Movement Meal Team, we feel question 2 is less important. There is considerable evidence that growth monitoring can be a challenge in many settings and often GMP programs don't work. We think it best to focus on items 1, 3, and 4 if DHS seeks to reduce the number of questions asked.
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #17014 is a reply to message #16770] Fri, 15 March 2019 06:55 Go to previous messageGo to next message
Nsia is currently offline  Nsia
Messages: 5
Registered: March 2019
Member
I endorse these questions
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #17018 is a reply to message #16770] Fri, 15 March 2019 07:02 Go to previous messageGo to next message
Paula Kawiche is currently offline  Paula Kawiche
Messages: 9
Registered: March 2019
Member
I indorse these questions
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #17070 is a reply to message #16770] Fri, 15 March 2019 10:32 Go to previous messageGo to next message
aperry is currently offline  aperry
Messages: 9
Registered: March 2019
Member
Understanding / improving the coverage of nutrition interventions as part of ANC is a priority - particularly given importance for the health of both mothers and their infants and so the DFID Nutrition Policy team supports this proposal. Although we do support inclusion of question 4, care will be needed when designing questions on access to cash / food assistance given the multitude of services that can be available in some countries and the challenge this might present when it comes to collecting these data.
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #17121 is a reply to message #16770] Fri, 15 March 2019 14:24 Go to previous messageGo to next message
salayon is currently offline  salayon
Messages: 7
Registered: January 2019
Member
I fully endorse these recommendations.
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #17145 is a reply to message #16770] Fri, 15 March 2019 15:04 Go to previous messageGo to next message
PATH is currently offline  PATH
Messages: 8
Registered: March 2019
Member
Thanks to DataDENT for compiling these indicators. If you decide to include the indicators proposed, we suggest considering some of the following:

Indicator #4  We too agree with some of the above comments, specifically that cash and food assistance should be separated, if included at all.

Additionally, please consider during the updating of your tabulation plan, the IPTP guidelines for ANC, in line with "positive pregnancy experience" guidelines/recommendation particularly number of visits, dose of folate, and IPTP. See: https://apps.who.int/iris/bitstream/handle/10665/250796/9789 241549912-eng.pdf;jsessionid=5217E7F88EA53BD2D86DADED04A4EFDA?sequence=1
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #17169 is a reply to message #16770] Fri, 15 March 2019 15:26 Go to previous messageGo to next message
1000 Days is currently offline  1000 Days
Messages: 10
Registered: March 2019
Member
1,000 Days is the leading non-profit organization working in the U.S. and around the world to improve nutrition and ensure women and children have the healthiest first 1,000 days.
We support the four indicators and the associated additions to the respective DHS-7 question. If it is possible to add more about what the health care provider's dietary recommendations were, as opposed to just a "yes" or "no" answer, that may also provide insight into the quality of care and counseling.
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #17328 is a reply to message #16770] Fri, 15 March 2019 17:44 Go to previous messageGo to next message
Erin Milner is currently offline  Erin Milner
Messages: 9
Registered: February 2019
Member
USAID supports this recommendation.
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #17348 is a reply to message #17328] Fri, 15 March 2019 18:04 Go to previous messageGo to next message
ktripp is currently offline  ktripp
Messages: 6
Registered: March 2019
Member
Abt Associates supports these recommendations but if there is a need to prioritize questions would suggest removing question 2.
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #17353 is a reply to message #16770] Fri, 15 March 2019 18:17 Go to previous messageGo to next message
Rolf Klemm is currently offline  Rolf Klemm
Messages: 7
Registered: March 2019
Member
HKI wishes to endorse the first two Nutritional Interventions during Antenatal Care (ANC) recommendations for inclusion in DHS-8 (2018-2023).
We have had field experience testing question 1 during survey work in Bangladesh, with a two-year recall period as is now the recommendation, and we found the question was easily understood and correlated well with better growth outcomes. We also believe that indicator 2 on taking maternal weight during ANC would be easy to add to the questionnaire module.

HKI, JPGSPH, "State of Food Security and Nutrition in Bangladesh: 2014" (Dhaka, BD, 2016).

We are less certain of the use of questions 3 and 4. For question 3, we are not certain if the respondent will be able to judge that the weight information was used in the discussion. A separate composite indicator could be produced form question 1 and 2 with much the same meaning.

For question 4, it is unclear if the respondent will know if the program was linked to the pregnancy or just given at the same time. Even if not linked to the pregnancy, access to such support is useful information but the use of the information is unclear.
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #17403 is a reply to message #17353] Fri, 15 March 2019 22:29 Go to previous messageGo to next message
gwg is currently offline  gwg
Messages: 2
Registered: March 2019
Member
I support the recommendation for including the 4 questions proposed by DataDENT, and using the recall period of 2 years to minimize respondent burden.
Data on coverage of nutrition-specific interventions that aim to improve pregnancy and neonatal outcomes are virtually unavailable (except for delivery and intake of iron and folic acid supplements during pregnancy). Thus, including all the proposed questions would be useful for designing and evaluating maternal health and nutrition programs. This has been my observation as a current doctoral candidate at Cornell and a nutritionist working closely with public health programs on maternal and child nutrition in S. Asia.

On #2 and #3: Since the DHS "Supplemental Module on Maternal Health Care" already asks about weight measured during (at least once) ANC visit, retaining this question with the proposed modification of "at least two ANC visits" does not seem burdensome. In fact, when we know little about coverage of nutrition-specific interventions that target pregnant women, it would be useful to assess prevalence of weight monitoring during pregnancy with question 2, and then assess promotion of weight gain during pregnancy with question 3.

On #4: To assess whether cash/food assistance was received in relation to pregnancy, I propose a small change: 'Received food or cash assistance during pregnancy from government, religious institution or NGO program "after ANC registration"'
OR 'Received food or cash assistance during pregnancy from government, religious institution or NGO program"upon identification of pregnancy"'
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #17413 is a reply to message #17328] Fri, 15 March 2019 23:21 Go to previous messageGo to next message
Judy Canahuati is currently offline  Judy Canahuati
Messages: 9
Registered: March 2019
Member
La Leche League International supports this recommendation
Re: Coverage of Nutritional Interventions during Antenatal Care (ANC) [message #17417 is a reply to message #16770] Fri, 15 March 2019 23:28 Go to previous message
Olutayo
Messages: 12
Registered: March 2019
Member
I support the inclusion of the indicator and the associated questions. Understanding determinants of poor nutrition outcomes, including inadequate program coverage, is necessary to effectively address the issue. The fact that most countries are not on track to meet WHA 2025 nutrition goals show that we need to do things differently or better, and there can be no meaningful action without the right data to guide such action.

[Updated on: Fri, 15 March 2019 23:28]

Report message to a moderator

Previous Topic: Minimum Dietary Diversity for Women (MDD-W) and Unhealthy Diets
Next Topic: Food Fortification: Household Coverage of Fortifiable Foods
Goto Forum:
  


Current Time: Thu Dec 12 20:14:09 Eastern Standard Time 2019